Just Another Pelvic Mass?

Objectives: To describe the case of a patient presenting with weight loss and a pelvic mass. Materials and methods: We performed an advanced search in MEDLINE using the key words "wasting syndrome", "actinomycosis" and "pelvic mass". Results: A 63-year-old woman had a well-delimited and tender pelvic mass and was found to be anaemic. Before scans were performed, clinicians considered malignancy and other diagnoses. Conclusion: Actinomycosis is a chronic infection that usually affects the abdomen. Because of the lack of specificity of clinical and radiological findings, a multidisciplinary approach is the keypoint for making an accurate diagnosis

Risk of recurrent venous thromboembolism in patients with autoimmune diseases:data from the Registro Informatizado de Enfermedad TromboEmbolica (RIETE) registry

Autoimmune disease is a risk factor for first incident venous thromboembolism (VTE). However, data on the risk of recurrent VTE in people with autoimmune disease is sparse. We explored the risk of recurrent VTE using the RIETE registry, comparing people with autoimmune disease (n = 1305) to those without (n = 50608). Overall rates were 6.5 and 5.1 recurrent VTE/100 years for patients with autoimmune disease vs controls, respectively. After adjustment for sex and unprovoked/provoked VTE yielded an adjusted hazard ratio of 1.29 (95%CI 1.03-1.62). The analysis was limited by short median follow up time (161 days overall), precluding definitive conclusions on recurrent VTE risks

Estudio comparativo entre pacientes EPOC ingresados en hospitalización a domicilio y hospitalización convencional

Aim: To demonstrate the risk derived from Conventional Hospitalization (CH) when it can be replaced by Hospital at Home (HAH) units in the context of Chronic Obstructive Pulmonary Disease exacerbations.Patients and methods: Historical cohort study with retrospective and comparative data analysis in which patients admitted to HAD are selected from 2010 to the present. 30 patients with exacerbation of who met criteria for admission to HAH and entered HAH, compared with 30 patients who met HAH criterion but who entered CH.Results: There were no differences in the baseline characteristics of the two groups. Hospital readmissions and mortality due to exacerbation of COPD and other causes were measured onemonth after discharge. In the CH group, greater re-admission due to exacerbation of COPD was observed .333 (CI 0.118-0.943), greater global readmission 0.345 (CI 0.155-0.772) and greater overall mortality 0.103 (CI 0.15-0.696).Conclusions: Our study suggests that there is an increased risk of readmission and mortality after one month attributable to HC after an episode of exacerbation of COPD.Objetivo: Demostrar el riesgo añadido derivado de la Hospitalización Convencional (HC) cuando ésta puede ser sustituida por la Hospitalización a Domicilio (HAD) en el contextode reagudizaciones de Enfermedad Pulmonar Obstructiva Crónica (EPOC).Pacientes y métodos: Estudio de cohortes histórico con análisis retrospectivo y comparativo de datos en que se seleccionan pacientes ingresados en HAD desde el 2010 hasta la actualidad. Se comparan 30 pacientes con reagudización de EPOC que cumplían criterios de ingreso en HAD e ingresan en HAD con 30 pacientes con reagudización de EPOC que cumplían criterio de HAD, pero ingresan en HC.Resultados: No se apreciaron diferencias en las características basales de los dos grupos. Se midieron los reingresos en el hospital y la mortalidad por reagudización de EPOC y por otras causas al mes del alta. En el grupo HC se observó mayor reingreso por reagudización de EPOC0,333 (IC 0,118-0,943), mayor reingreso global 0,345 (IC 0,155-0,772) así como mayor mortalidad global 0,103 (IC 0,15-0,696).Conclusiones: Nuestro estudio sugiere que existe un riesgo aumentado de reingreso y mortalidad al mes atribuible a la HC tras un episodio de reagudización de EPOC

Comparison of seven prognostic tools to identify low-risk pulmonary embolism in patients aged <50 years

publishersversionPeer reviewe

Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism

Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90-day all-cause (odds ratio [OR], 2.81; 95% CI, 2.33-3.38) and PE-related mortality (OR, 2.38; 95% CI, 1.37-4.14) and increased 1-year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10-9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all-cause mortality (OR, 1.91; 95% CI, 1.57-2.32) but not PE-related mortality (OR, 1.50; 95% CI, 0.85-2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR, 2.28; 95% CI, 1.75-2.97) and PE-related (OR, 3.64; 95% CI, 2.01-6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.info:eu-repo/semantics/publishedVersio

Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients.OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference.DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries.MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation.RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P &lt; 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P &lt; 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT.CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223

Hemomediastino en tomador de rivaroxaban

Varón de 85 años anticoagulado con Rivaroxaban por una fibrilación auricular, que acude por traumatismo costal izquierdo. El paciente se encontraba en tratamiento con nuevos antcoagulantes (NACOS)debido al antecedente de una hemorragia craneal en relación con Warfarina. Tras objetivarse varias fracturas izquierdas, se decide tratamiento conservador. A las 24 horas, sufre mareo por lo que se re-explora, objetivándose hipoventilación derecha

Severe Acute Infection Due to Serratia marcescens Causing Respiratory Distress in An Immunocompetent Adult

The role of Serratia marcescens changed from a harmless saprophytic microorganism to an important opportunistic human pathogen. It often causes nosocomial device-associated outbreaks and rarely serious invasive community acquired infections. We present a case of a community-acquired Serratia marcescens bacteremia leading to Respiratory Distress Syndrome in a previously healthy 51-year-old man without identifiable risk factors. Full recovery was achieved with solely medical treatment and observation in ICU during three days. To our knowledge it is an extremely uncommon presentation and just few cases have been previously reported in the literature